Technical Nuances and Approach-related Morbidity of Anterolateral and Posterolateral Lumbar Corpectomy Approaches-a Systematic Review of the Literature

Overview

Journal Acta Neurochir (Wien)

Specialty Neurosurgery

Date 2022 Jun 11

PMID 35689694

Authors

Christoph Wipplinger

Sara Lener

Christoph Orban

Tamara M Wipplinger

Anto Abramovic

Anna Lang

Sebastian Hartmann

Claudius Thome

Affiliations

Soon will be listed here.

Abstract

Purpose: Approaches for lumbar corpectomies can be roughly categorized into anterolateral (AL) and posterolateral (PL) approaches. It remains controversial to date whether one approach is superior to the other, and no comparative studies exist for the two approaches for lumbar corpectomies.

Methods: A systematic review of the literature was performed through a MEDLINE/PubMed search. Studies and case reports describing technique plus outcomes and possible complications were included. Thereafter, estimated blood loss (EBL), length of operation (LOO), utilized implants, neurological outcomes, complication rates, and reoperation rates were analyzed.

Results: A total of 64 articles reporting on 702 patients including 513 AL and 189 PL corpectomies were included in this paper. All patients in the PL group were instrumented via the same approach used for corpectomy, while in the AL group the majority (68.3%) of authors described the use of an additional approach for instrumentation. The EBL was higher in the AL group (1393 ± 1341 ml vs. 982 ± 567 ml). The LOO also was higher in the AL group (317 ± 178 min vs. 258 ± 93 min). The complication rate (20.5% vs. 29.1%, p = 0.048) and the revision rate (3.1% vs. 9.5%, p = 0.004) were higher in the PL group. Neurological improvement rates were 43.8% (AL) vs. 39.2% (PL), and deterioration was only noted in the AL group (6.0%), while 50.2% (AL) and 60.8% (PL) showed no change from initial presentation to the last follow-up.

Conclusion: While neurological outcomes of both approaches are comparable, the results of the present review demonstrated lower complication and revision rates in anterolateral corpectomies. Nevertheless, individual patient characteristics must be considered in decision-making.

Citing Articles

Spine surgery and readmission: Risk factors in lumbar corpectomy patients.

Gerstmeyer J, Gorbacheva A, Avantaggio A, Pierre C, Yilmaz E, Schildhauer T N Am Spine Soc J. 2025; 21:100587.

PMID: 39995804 PMC: 11848789. DOI: 10.1016/j.xnsj.2025.100587.

Single- and Multilevel Corpectomy and Vertebral body replacement for treatment of spinal infections. A retrospective single-center study of 100 cases.

Neuhoff J, Berkulian O, Kramer A, Thavarajasingam S, Wengert A, Schleicher P Brain Spine. 2024; 4:102721.

PMID: 38510622 PMC: 10951701. DOI: 10.1016/j.bas.2023.102721.

References

Liljenqvist U, Lerner T, Bullmann V, Hackenberg L, Halm H, Winkelmann W . Titanium cages in the surgical treatment of severe vertebral osteomyelitis. Eur Spine J. 2003; 12(6):606-12. PMC: 3467979. DOI: 10.1007/s00586-003-0614-z. View

Alhashash M, Shousha M . Minimally Invasive Short-Segment Anteroposterior Surgery for Thoracolumbar Osteoporotic Fractures with Canal Compromise: A Prospective Study with a Minimum 2-Year Follow-up. Asian Spine J. 2021; 16(1):28-37. PMC: 8874002. DOI: 10.31616/asj.2020.0573. View

Gassie K, Erben Y, Fortich S, Carames G, Sandhu S, Abode-Iyamah K . Multilevel L4 and L5 Corpectomy for Burst Fracture via an Anterior Transperitoneal Approach Followed by Posterior Stabilization: Technical and Anatomic Considerations. Cureus. 2021; 13(10):e18579. PMC: 8572031. DOI: 10.7759/cureus.18579. View

Cho Y . Corpectomy and circumferential fusion for advanced thoracolumbar Kümmell's disease. Musculoskelet Surg. 2017; 101(3):269-274. DOI: 10.1007/s12306-017-0480-1. View

Singh Dhillon C, Nanakkal A, Chhasatia N, Medagam N, Khatavi A . A Rare Case of Contiguous Three-level Lumbar Burst Fractures-treated with Combined Posterior Stabilization and Anterior Fusion. J Orthop Case Rep. 2021; 11(2):71-75. PMC: 8180315. DOI: 10.13107/jocr.2021.v11.i02.2032. View

Tanaka M, Singh M, Fujiwara Y, Uotani K, Arataki S, Yamauchi T . Minimally Invasive Thoracolumbar Corpectomy and Percutaneous Pedicle Screw Fixation with Computer-Assisted Rod-Bending System in Single Lateral Position: Technical Note. World Neurosurg. 2021; 151:138-144. DOI: 10.1016/j.wneu.2021.05.028. View

Pekmezci M, Tang J, Cheng L, Modak A, McClellan R, Buckley J . Comparison of expandable and fixed interbody cages in a human cadaver corpectomy model, part I: endplate force characteristics. J Neurosurg Spine. 2012; 17(4):321-6. DOI: 10.3171/2012.7.SPINE12171. View

Gallia G, Sciubba D, Bydon A, Suk I, Wolinsky J, Ziya L Gokaslan . Total L-5 spondylectomy and reconstruction of the lumbosacral junction. Technical note. J Neurosurg Spine. 2007; 7(1):103-11. DOI: 10.3171/SPI-07/07/103. View

Theologis A, Tabaraee E, Toogood P, Kennedy A, Birk H, McClellan R . Anterior corpectomy via the mini-open, extreme lateral, transpsoas approach combined with short-segment posterior fixation for single-level traumatic lumbar burst fractures: analysis of health-related quality of life outcomes and patient satisfaction. J Neurosurg Spine. 2015; 24(1):60-8. DOI: 10.3171/2015.4.SPINE14944. View

10.

Srikantha U, Lokanath Y, Hari A, Nirmala S, Varma R . Minimally invasive lateral transpsoas approach for lumbar corpectomy and stabilization. Surg Neurol Int. 2019; 10:153. PMC: 6744737. DOI: 10.25259/SNI_292_2019. View

11.

Korovessis P, Repantis T, Iliopoulos P, Hadjipavlou A . Beneficial influence of titanium mesh cage on infection healing and spinal reconstruction in hematogenous septic spondylitis: a retrospective analysis of surgical outcome of twenty-five consecutive cases and review of literature. Spine (Phila Pa 1976). 2008; 33(21):E759-67. DOI: 10.1097/BRS.0b013e318187875e. View

12.

Lu D, Wang V, Chou D . The use of allograft or autograft and expandable titanium cages for the treatment of vertebral osteomyelitis. Neurosurgery. 2009; 64(1):122-9. DOI: 10.1227/01.NEU.0000336332.11957.0B. View

13.

Senel A, Kaya A, Kuruoglu E, Celik F . Circumferential stabilization with ghost screwing after posterior resection of spinal metastases via transpedicular route. Neurosurg Rev. 2007; 30(2):131-7. DOI: 10.1007/s10143-007-0067-7. View

14.

Oxland T . Fundamental biomechanics of the spine--What we have learned in the past 25 years and future directions. J Biomech. 2015; 49(6):817-832. DOI: 10.1016/j.jbiomech.2015.10.035. View

15.

Chou D, Lu D . Mini-open transpedicular corpectomies with expandable cage reconstruction. Technical note. J Neurosurg Spine. 2010; 14(1):71-7. DOI: 10.3171/2010.10.SPINE091009. View

16.

Nakashima H, Kanemura T, Satake K, Ito K, Tanaka S, Segi N . Transdiaphragmatic Approach as a Novel Less Invasive Retroperitoneal Approach at Thoracolumbar Junction: Comparison with Conventional Diaphragmatic Incision. Spine Surg Relat Res. 2021; 5(6):405-411. PMC: 8668210. DOI: 10.22603/ssrr.2020-0191. View

17.

Walker C, Xu D, Godzik J, Turner J, Uribe J, Smith W . Minimally invasive surgery for thoracolumbar spinal trauma. Ann Transl Med. 2018; 6(6):102. PMC: 5900064. DOI: 10.21037/atm.2018.02.10. View

18.

Carminucci A, Assina R, Hernandez R, Goldstein I . Direct Midline Posterior Corpectomy and Fusion of a Lumbar Burst Fracture with Retrospondyloptosis. World Neurosurg. 2017; 99:809.e11-809.e14. DOI: 10.1016/j.wneu.2016.12.129. View

19.

Pham M, Tuchman A, Chen T, Acosta F, Hsieh P, Liu J . Transpedicular Corpectomy and Cage Placement in the Treatment of Traumatic Lumbar Burst Fractures. Clin Spine Surg. 2017; 30(8):360-366. DOI: 10.1097/BSD.0000000000000312. View

20.

Detwiler P, Porter R, Crawford N, Apostolides P, Dickman C . Lumbosacral junction fixation and fusion after complete L-5 spondylectomy. Case report. Neurosurg Focus. 2006; 7(6):e3. View